During a recent junket to our State’s Capitol on behalf of two well known and altruistic organizations, I was reminded of the conventional wisdom that there are two things you should not witness being made, sausage and laws (well, ok, there are actually three things you should not watch being made, but decorum prevents me from mentioning the third)…

That being said, take a look at some of the headlines this week from EMS Network News relating to significant public policy issues:

EMS consolidation set to begin in July - Nashville, Tennessee

Efforts remain stalled on ambulance contract - Monroe, Ohio

Firefighter union, city trade barbs over AMR - Spokane, Washington

Threat of losing EMS helps pass ambulance tax - Beach Park, Illinois

Officials want to merge fire department, EMS - Townsend, Massachusetts

Task force examines options for ambulances - Morgan County, Indiana

How do you change an EMS system to make it as effective and efficient as possible in the face of turf battles, autonomy struggles and strained relationships between providers and jurisdictions?

Many EMS systems continue to be plagued by lack of coordinated clinical protocols and CQI processes, refusals to respond to medical calls across jurisdictional boundaries, agencies refusing to submit data for system evaluation, multiple call transfers for 9-1-1 EMS requests and too few 9-1-1 centers providing EMD pre-arrival instructions.

If negotiation, compromise and patient-focused reasonableness fail, you must influence difficult public policy decisions.  Influencing public policy is both science and art…  Here are some tips on negotiating the minefield that experience has proven reasonably effective.

Focus on the patient, but be aware of the politics.  Make all your suggested changes virtually impossible for detractors to dispute in a public forum.  Ensure the citizenry, the media and elected officials see the value of the changes. Continuously measure leadership support for the initiative.  Try to determine and address root causes if leadership support wanes.

Distinguish rhetoric from reality.  Assemble as much data as possible because data is a must for sound public policy changes.  For example, when promoting a requirement for neighboring jurisdictions to provide closest unit response across arbitrarily drawn geopolitical boundaries, one jurisdiction may argue that it would be a “donor” agency, giving more resources than their neighbor than they would receive in a closest-unit response requirement. Do your homework – look at actual response data to be sure the argument is based on fact, not conjecture.

Draw the sting!  Be prepared for detractors. Look at the changes through their eyes, and prepare to defend your position from the high ground.  When making public presentations, defuse the opposition by stating their issues up front and refuting them.  Using the closest unit response scenario again, some groups opposing the changes may state that the changes would mean added workloads and costs.  Analyze the data in advance and report how much time the average agency to be effected was actually on a call. In one local case, it was as low as 4.6% of the time.  In this case, even a doubling of the workload would mean the agency was still available for a call more than 90% of the time.  That’s a hard argument to counter.

Communicate, communicate, communicate.  Garner support from internal and external stakeholders as if you are running a political campaign – in essence, you are!  Start the communication process, and it will develop a life of its own because each person educated on your issues may become a spokesperson for the effort.  Focus on elected officials, and brief them early, before your proposal hits the street.  As soon as the word does get out, they will start getting calls; so give them the information they need to respond appropriately to questions.  Identify every stakeholder group, especially those that may be opposed.  Let them hear directly from you in person, instead of through the rumor mill.  Get the word out to the media. Meet early on with newspaper editorial boards and radio personalities, appear on talk shows and invite the media to virtually every briefing you have with stakeholder groups.

Use studies that support your changes. Propose policy changes supported by studies or national research. If you have not had local studies done, use sources such as the American Heart Association, the National Association of EMS Physicians, the National Association of State EMS Directors, the National Academy for Emergency Medical Dispatch, local and national news stories or other similar resources.

Recognize those who will always oppose change.  Whenever possible, collaboration on mutually beneficial changes is the best route.  However, it is naïve to think that everyone can agree on all policy issues.  If negotiation and diplomacy don’t work, pick the high-road, patient focused argument and move forward.  Sometimes it is more productive to first draft an actual document, then invite stakeholder feedback using a structured format. This allows opposing stakeholders to offer revisions to the proposed changes while maintaining focus on solutions to the problems you are trying to solve.

Acknowledge and respond to all feedback. It’s a good idea to use the Federal Register format for feedback response.  Send letters acknowledging each written response, then summarize the feedback, recommendations and what changes, if any, you will incorporate into the policy.